Information is not Enough: The Place of Statistics in the Doctor-Patient Relationship

Abstract

The hero of Leo Tolstoy’s The Death of Ivan Ilych is a man of “incorruptible honesty,” who prides himself on his work as an examining magistrate:

Ivan Ilych never abused his power; he tried on the contrary to soften its expression, but the consciousness of it and of the possibility of softening its effect supplied the chief interest and attraction of his office. In his work itself...he very soon acquired a method of eliminating all considerations irrelevant to the legal aspect of the case, and reducing even the most complicated case to a form in which it would be presented on paper only in its externals, completely excluding his personal opinion of the matter, while above all observing every prescribed formality.1

Peter Angelos, “Patterns of Physician-Patient Communication: Results of Preliminary Studies,” presented to a symposium in honor of David L. Nahrwold, Northwestern University Medical School, 27 February 1998.Google Scholar

Howard Brody, however, has made it the core of the conversational ethics he describes as essential to primary care and highly useful in sub-specialty medicine; see The Healer’s Power (New Haven: Yale University Press, 1992).Google Scholar

8.

The phrase has been in use for more than a decade, but there is no better illustration of it than Reynolds Price’s account of being told his diagnosis, tout court, in a busy hallway of the Duke University Hospital by two young specialists who then turned and rushed off to other, more important duties: A Whole New Life: An Illness and A Healing (New York: Penguin/Plume, 1994).Google Scholar

9.

Kahneman D, Tversky A. The framing of decisions and the psychology of choice. Science 1981;211:453–58. See also their earlier Judgment under uncertainty. Science 1974;185: 1124-31.PubMedCrossRefGoogle Scholar

Philosophers and sociologists of science have long described science as more contextual and socially constructed, but when it comes to medicine, physicians and the general public still subscribe to the now out-dated Newtonian, positivist view.Google Scholar